Recently, I’ve felt a shift in the timeline. Part of this I can attribute to having less time to myself as I ease into chief resident duties. Time I would’ve spent doing (or postponing) other activities is now relegated to this new role. But this increased demand on my time is not the only factor. Time feels like it is more rapidly passing with each year of residency, and more accelerated as of late.
Taking the annual RISE this time of year also contributes to this. I’m reminded that I should have reached some invisible bar on the meter stick in terms of my knowledge base and hope that I am commensurate with where I should be at this point in my residency. Because sooner than I may feel comfortable with, I will be expected to be “competent” enough to serve as a junior attending during my fellowships. And even though I’ve put it off until a later date, I know that I should also start composing a study plan soon for my boards because time is short between now and graduation.
Lately, probably because it was my most recent rotation, I’m reminded of my surgpath fellows during my PGY-1 telling me that I would learn the most from my cases, both AP and CP. Even though I was listening, I don’t think that I quite understood the depth of those words until my third year. During residency, we often don’t have much time to think because our service duties occupy much of that time. And the desire and need for sleep occupies much of the remainder of the time. But the light bulb moment has gone off so to speak in terms of what they meant by “learning from my cases” – be deliberate and start early.
For much of my first two years, as I’ve previously written, I’ve had a love/hate relationship with surgpath. Maybe those words are too strong, because I neither loved nor hated it, more like was ambivalent toward it. I naturally gravitated toward those subspecialties (obviously not surgpath) that I felt more comfortable with because of my previous training and interests – we all do.
But now I find that grossing is more meaningful and less of a chore to get through for me because I truly understand now how important it is that I do it well – be able to identify the important lesions and sections (90-95% of the diagnosis is off the gross, after all), cut thin and deliberate sections that look like “sushi” as one resident described my grossing, and understand how the sections I provide contribute to staging in the case of cancers. I understand these aspects better now because my grossing skill was called into question during my 2nd year. Since then, I’ve put a good amount of effort into correcting any deficiencies. Even the rotation director who originally brought up this issue, joked about the disasters of my first day on surgpath at his hospital at every end-of-the-rotation evaluation I had since then. His method of feedback may have been dramatic at the time but he really did provide me with a defining moment that changed my outlook and approach and for that I am grateful.
But it’s necessary to be deliberate and start early whatever rotation you’re on. Even though I read about the diagnoses for most of my big resection cases or at least did a quick pathology outlines search each time, I really wish that I would’ve spent even more time really reading up on those cases besides the cursory skim to come up with a diagnosis earlier in my residency. These days, I try to read a little every day, whether it be from a textbook or a journal article. And I’ve found that my knowledge, understanding, and skills improve at a faster rate. But I do wish that I had started this process from my PGY-1 so that I wouldn’t feel like I’m behind where I should be in terms of being ready for boards…so that I didn’t feel like I’m going to have to cram like I used to during college and med school for boards or wonder how to retain info that I learned two years ago on a rotation I haven’t had since PGY-1.
So really listen to the feedback from those more experienced then you. It probably took them longer than they would’ve liked to get to that light bulb moment. That is probably why they are making it a point to bring up that pearl of wisdom to you that they should’ve and wished they could’ve known then.
-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.